New stroke reccomendations

In reviewing the new ASA guidelines regarding acute stroke treatment they basically say you should give IV rtPA to all eligible patients. They recommend IA thrombolysis only for patients with a significant MCA occlusion with a last time normal < 6 hours who are otherwise not candidates for IV rtPA. It appears that no IR procedures are recommended for posterior circulation strokes at this time. I have copy and pasted the specific recommendations below. For all other interventional approaches they recommend further evaluation within the context of clinical trials. Note the new language regarding the qualifications of interventionalists that has been added.

Class I Recommendations
Intra-arterial thrombolysis is an option for treatment of selected patients who have major stroke of <6 hours’ duration due to occlusions of the MCA and who are not otherwise candidates for intravenous rtPA (Class I, Level of Evidence B). This recommendation has not changed since previous guidelines.
Treatment requires the patient to be at an experienced stroke center with immediate access to cerebral angiography and qualified interventionalists. Facilities are encouraged to define criteria to credential individuals who can perform intra-arterial thrombolysis (Class I, Level of Evidence C). This recommendation has been added since previous guidelines.
Class II Recommendation
Intra-arterial thrombolysis is reasonable in patients who have contraindications to use of intravenous thrombolysis, such as recent surgery (Class IIa, Level of Evidence C). This recommendation was not included in the previous guideline.
Class III Recommendation
The availability of intra-arterial thrombolysis should generally not preclude the intravenous administration of rtPA in otherwise eligible patients (Class III, Level of Evidence C). This recommendation has not changed from previous guidelines.
Also, here are the new recommendations regarding imaging in acute stroke:

Class I Recommendations
Imaging of the brain is recommended before initiating any specific therapy to treat acute ischemic stroke (Class I, Level of Evidence A). This recommendation has not changed from the previous guideline.
In most instances, CT will provide the information to make decisions about emergency management (Class I, Level of Evidence A). This recommendation has not changed from the previous guideline.
The brain imaging study should be interpreted by a physician with expertise in reading CT or MRI studies of the brain (Class I, Level of Evidence C). This recommendation has been added since the previous guideline.
Some findings on CT, including the presence of a dense artery sign, are associated with poor outcomes after stroke (Class I, Level of Evidence A). This recommendation has not changed from the previous guideline.
Multimodal CT and MRI may provide additional information that will improve diagnosis of ischemic stroke (Class I, Level of Evidence A). This recommendation has been added since the previous guideline.
Class II Recommendations
Nevertheless, data are insufficient to state that, with the exception of hemorrhage, any specific CT finding (including evidence of ischemia affecting more than one third of a cerebral hemisphere) should preclude treatment with rtPA within 3 hours of onset of stroke (Class IIb, Level of Evidence A). This recommendation has not changed from the previous guideline.
Vascular imaging is necessary as a preliminary step for intra-arterial administration of pharmacological agents, surgical procedures, or endovascular interventions (Class IIa, Level of Evidence B). This recommendation has not changed from the previous guideline.
Class III Recommendations
Emergency treatment of stroke should not be delayed in order to obtain multimodal imaging studies (Class III, Level of Evidence C). This recommendation has been added since the previous guideline.
Vascular imaging should not delay treatment of patients whose symptoms started <3 hours ago and who have acute ischemic stroke (Class III, Level of Evidence B). This recommendation has been added since the previous guideline.